vol. 0 • no. 0 American Journal of Lifestyle Medicine Favour T. Adebusoye, MBBS , Wireko A. Awuah, MBBS, Pearl O. Tenkorang, MBChB, Jack Wellington, MSc (LSHTM), FGMS, Toufik Abdul-Rahman, MBBS, Shankhaneel Ghosh, MBBS, Lydia Abiy, MBBS, Anastasia F. Debrah, MBBS, and Natalia Dryha, MD The Prevalence of Sedentary Habits Among International Students in Eastern Ukraine - A Cross-Sectional Study Abstract: Objectives: To determine aware of the impact of substance use Introduction the occurrence of the behavioral risk on their health. Conclusion: A Inadequate physical activity is factors associated with non- significant number of students a significant factor that contributes to communicable diseases among engage in unhealthy behaviors. the development of non- international undergraduate Despite this, most students reported communicable diseases (NCDs).1 students. Methods: A cross-sectional having good health, with only a small According to the World Health study of 155 international percentage engaging in regular Organization (WHO), a majority of undergraduate students originating physical activity. The prevalence of adolescents and a significant from 13 different countries, was asked these unhealthy behaviors highlights to complete a 26-question survey organized into 5 sections: demographics, physical activity, ‘“Having a large number of smoking substance use, dietary habits, and health assessment. The online survey family members and friends may was distributed via social media platforms such as Viber, Telegram, contribute to the high percentage of WhatsApp, email, and Instagram. student smokers.” Results: The majority of surveyed ’ students (86%) had good or excellent capacity for everyday activities, and the need for educational institutions number of adults do not engage in 62.6%utilized their electronic gadgets to provide support and resources to enough physical activity to maintain for at least 8 h daily. 67.1% were promote healthy lifestyles, including good health.2 This, coupled with the regular consumers of junk food, and health assessments, health coaching, consumption of ultra-processed 53.5% did not get medical checkups. and social activities. foods, the lack of preventative health Students addicted to tobacco and/or screenings, and the habitual use of cigarettes constituted 52.6% of the Keywords: sedentary behavior; substances like alcohol and tobacco, sample, 38.1% were regular alcohol dietary habits; non-communicable increases the risk of developing consumers, and 97.4% reported being diseases; physical inactivity NCDs.1,3–5 These lifestyle factors DOI: 10.1177/15598276231184166. Sumy State University, Sumy, Ukraine; Medical School, University of Ghana, Accra, Ghana; School of Medicine, Cardiff University, Wales, UK; Sumy State University, Sumy, Ukraine; Institute of Medical Sciences and SUM Hospital, Siksha ‘O’ Anusandhan, Bhubaneswar, India; Donetsk National Medical University, Kropyvnytskyi, Ukraine; and Sumy State University, Sumy, Ukraine. Address correspondence to: Favour T. Adebusoye, MBBS, Sumy State University, Zamonstanksya 7, Sumy 40007, Ukraine. e-mail: favouradebusoye@gmail.com. For reprints and permissions queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav. Copyright © 2023 The Author(s). 1 American Journal of Lifestyle Medicine nn–nn 2023 place stress on healthcare resources is vital to prioritize students’ health demographics, physical activity, and increase the risk of early and well-being in order to ensure substance use, dietary habits, and mortality.2 Ultimately, reducing a healthier future workforce. health assessment. In addition to the sedentary behaviors can substantially Our study aims to be one of the first author’s tailored questions, the decrease the risk of NCDs such as or very few on sedentary behaviors survey included the WHO’s Global diabetes mellitus, cardiovascular among foreign students in Eastern School-Based Student Health disease, obesity, and cancer.6 Europe, as studies such as these are Survey.12 Due to several aetiologies, including currently limited in the existing The survey instrument was obesity and poverty, sedentary literature. developed after an extensive review behaviors are rising worldwide, of the relevant literature and especially in low- and middle-income research objectives. To confirm the Methods countries (LMICs). Individuals and questionnaire’s validity and their respective families may possess Participants and Settings reliability, it was pre-tested with limited financial resources, whereby International undergraduate a small group of participants who opting to consume less healthy, students from Sumy State University in were not included in the final affordable choices becomes Sumy, Ukraine, participated in the sample. The feedback from the instinctual due to reduced cross-sectional study. Out of the 1900 initial validation phase was used to accessibility.1,7 These behaviors are international students enrolled,11 improve the questionnaire, ensuring linked to negative health outcomes in a total of 207 were invited to clarity, relevance, and adolescents and present a significant participate in the study, with 155 comprehensibility. Furthermore, the challenge to human health in under- responding (a 74.9% response rate). study followed the guidelines of the resourced nations.1,7 This group represents 8.2% of the Strengthening the Reporting of Correspondingly, it is worth noting university’s international student Cohort, Cross-Sectional, and Case- that a significant portion of our study’s population. The participating students Control Studies in Surgery’ population originates from LMICs. (STROCSS).13were between 17 and 28 years old and In Ukraine, efforts have been made originated from 13 different countries to increase the physical activity of (Table 1). The study was conducted Assessment Measures and students and motivate them towards Data Collectionfrom October to November 2022 a healthy lifestyle, with programs using an online survey that was The data collected comprised such as “The State Targeted Social distributed via social media platforms demographic information such as Program for the Development of such as Viber, Telegram, WhatsApp, age, gender, country of origin, and Physical Culture and Sports for the email, and Instagram. year of study, as outlined in period up to 2020” and “The Ethical approval for this study was Table 1. Data on physical activity, National Strategy for the waived by the Sumy State University including the participants’ ability Improvement of Physical Activity in Ethics Committee, as the research to perform daily tasks, overall Ukraine for the period up to 2025” was deemed to pose minimal risk to health assessment, types of having yielded positive outcomes.8 participants. Informed consent was physical activities performed Despite these efforts, sedentary obtained from participants prior to (e.g., gym, home exercise, behaviors still persist among the online survey. Participants were walking), and the frequency of students, and physical activity has provided with a clear and detailed physical activities and electronic not seen much recent improvement explanation of the study aims and device use were also compiled or priority. methods, and were given the (Table 2). Given that many students will serve opportunity to ask questions. The questionnaire inquired about on future task forces for many Participants provided consent to the participants’ usage of alcohol businesses, it is crucial to recognize participate by clicking “I agree” after and cigarettes, including their and manage health concerns among reading a statement that explained frequency of use and if they students in order to mitigate this the study and their rights as possessed a habit of mixing alcohol impending issue.9 Conducting participants, including the right to and drugs or tobacco and cigarettes regular health checkups may help withdraw from the survey at any (Table 3). The survey also gathered identify and manage chronic time without penalty. information on whether friends and illnesses. Creating a social family members were habitual users environment that promotes health Survey Instrument of these substances (Table 3). literacy and encourages healthy Development and Validation Additionally, participants were lifestyles is crucial to reducing the The survey consisted of 26 asked if they were aware of the incidence of NCDs.10 In summary, it questions organized into 5 sections: negative health impacts of using 2 vol. 0 • no. 0 American Journal of Lifestyle Medicine Table 1. The Demographic Distribution of International Students Reported in Sumy State University. Characteristics Number of Students (n = 155) Percentage, % Gender Female 79 51 Male 76 49 Age 17-19 years 13 8.3 20-22 years 81 52.3 23-25 years 53 34.2 26-28 years 8 5.2 Year of study 1st 2 1.3 2nd 19 12.3 3rd 22 14.2 4th 50 32.3 5th 33 21.3 6th 29 18.7 Country of origin Nigeria 74 47.7 India 48 31 Ghana 9 5.8 Morocco 5 3.2 Tanzania 4 2.6 Zimbabwe 3 1.9 Kenya 3 1.9 Democratic Republic of Congo 3 1.9 Bangladesh 1 0.6 United Kingdom 1 0.6 Saudi Arabia 1 0.6 Germany 1 0.6 Italy 1 0.6 3 American Journal of Lifestyle Medicine nn–nn 2023 cigarettes, tobacco, alcohol, and and energy drinks and whether they opposed to junk food consumption other substances (Table 3). Data on cook their own meals or eat out, and were also amassed (Table 4). dietary preferences, such as how beliefs on the expenses associated Lastly, the questionnaire covered often individuals consume junk food with eating healthier foods as health assessment data, including Table 2. Student Health Capacity, Frequency of Physical Activity and Gadget Usage. Category Number of Students (n = 155) Percentage (%) Capacity for everyday activities Excellent 67 43.2% Good 66 42.6% Moderate 21 13.5% Severely or completely impaired 0 0% Physical health Good 128 82.6% Mild impairments 25 16.1% Moderate impairments 2 1.3% Severe or total impairments 0 0% Physical activity Gym activities 36 23.2% Home exercise 55 35.4% Recreational activities 32 20.7% No physical activities 32 20.7 Frequency of physical activity among those who perform everyday activities Never 43 27.7% Everyday 18 11.6% 2-3 times per week 35 22.6% 3-5 times per week 31 20.0% Once per week 28 18.1% Electronic device usage 1-2 h per day 6 3.8% 3-4 h per day 19 12.3% 5-6 h per day 33 21.3% 7-8 h per day 36 23.2% 8 h or more per day 97 62.0% 4 vol. 0 • no. 0 American Journal of Lifestyle Medicine Table 3. Substance Use Habits and Awareness of Its Effects on Health. Category Number of Students (n = 155) Percentage, % Alcohol and/or drugs Both 11 7.1 Drugs only 2 1.3 Alcohol only 59 38.1 Neither 83 53.5 Tobacco and cigarettes Both 69 44.5 Tobacco only 3 1.9 Cigarettes only 8 5.2 Neither 75 48.4 Cigarette smoking 1-5 cigarettes per day 28 35 6-10 cigarettes per day 16 20 10+ cigarettes per day 36 45 Alcohol consumption Everyday 54 34.8 1-2 times per week 5 3.2 Once per month 9 5.8 Special occasions 3 1.9 Never 84 54.3 Awareness of substance use effects on health Aware 151 97.4 Unaware 4 2.6 Social circles Friends habituated to substances 41 26.5 Family members habituated to substances 5 3.2 Both family and friends habituated to substances 19 12.3 Neither family nor friends habituated to substances 90 58 5 American Journal of Lifestyle Medicine nn–nn 2023 the frequency of routine medical diabetes mellitus, asthma, anxiety was the case, participants were also checkups, personal health scale, and obsessive-compulsive disorder, questioned about why they never presence of chronic NCDs (such as or hypothyroidism), and local underwent normal medical hypotension or hypertension, hospital conditions (Table 5). If this examinations. Table 4. Dietary Habits, Food Preferences and Perception of Food Costs. Category Number of Students (n = 155) Percentage, % Junk food consumption Nearly every day 45 7.1 1-2 times per week 37 1.3 3-4 times per week 22 38.1 Once per month 28 53.5 On special occasions 21 13.6 Never 2 1.3 Energy drink consumption Nearly every day 10 6.5 1-2 times per week 16 10.3 3-4 cigarettes per week 4 2.6 Once per month 19 12.3 Never 39 25.2 On special occasions 67 43.2 Preference for food preparation Self-prepared food 54 41.3 Eating out 5 51.6 No preference/do not know 9 7.1 Perception of cost: Eating healthy Expensive 70 45.2 Not expensive 68 43.9 Do not know 17 11 Perception of cost: Junk food Friends habituated to substances 41 43.2 Cheaper 67 42.6 Not cheaper 66 12.3 Do not know 22 14.2 6 vol. 0 • no. 0 American Journal of Lifestyle Medicine Table 5. Frequency of Medical Checkups, Self-Reported Health Status and Local Hospital Ratings. Category Number of Students (n = 155) Percentage, % Medical checkup frequency Nearly get a medical checkup 83 53.5 Every 6 months 32 20.6 Every year 25 16.1 Every 2 years 9 5.8 Every 3 years 6 3.9 Self-reported health ratings 10 26 16.8 9 48 31.0 8 41 26.5 7 22 14.2 6 5 3.2 5 9 5.8 4 0 0 3 2 1.3 2 1 0.6 1 1 0.6 Chronic disease status Yes 8 5.2 No 138 88.9 Do not know 9 5.8 Types of chronic disease High blood pressure 2 1.3 Diabetes 2 1.3 Anxiety and obsessive-compulsive disorder 2 1.2 Hypothyroidism 1 0.6 Low blood pressure 1 0.6 Rating of local hospitals Extremely poor 4 2.6 (continued) 7 American Journal of Lifestyle Medicine nn–nn 2023 Table 5. (continued) Below average 6 3.9 Average 68 43.9 Above average 49 31.6 Excellent 28 18.1 Data Analysis everyday activities, with 43.2% and the students reported that their Statistical processing and analysis 42.6% performing at excellent and friends were habituated to drugs, of the obtained data were performed good levels, respectively. In terms of alcohol, and cigarettes, while using Microsoft Excel programs physical health, most students a smaller percentage reported that using the methods of mathematical (82.6%) reported being in good their family members were statistics and the software package physical health, with only 16.1% and habituated (Table 3). Statistica 8.0. Tables were built using 1.3% reporting mild and moderate Dietary Habits Microsoft Excel. The mathematical physical impairments, respectively. processing of indicators was No students reported severe or total An estimated quarter of the performed using the methods of physical impairments (Table 2). The students who responded to the study variation statistics for comparing larger subset of students did not stated that they consumed junk food inhaled sets by averages using the engage in any physical activity daily, and over 7% disclosed energy Student-t test. A descriptive analysis (20.7%), while the rest engaged in drink consumption to be almost of variables was performed, and activities such as home exercise daily. A majority of the students odds ratios (OR) and 95% (35.4%), recreational (20.7%), or drank energy drinks on special confidence intervals (CI) were gym activities (23.2%). In addition, occasions, and approximately 25% determined. The sample size is the greater number of students who never drank them (Table 4). sufficient to provide results with engaged in everyday activities did Approximately half of the surveyed a theoretical error of less than 3%. not perform physical activity. students preferred eating outside, However, 11.6% of students while the other half preferred self- performed physical activity daily, prepared food. Almost half of the Results and 20% performed physical activity students thought that eating healthy Demographic Characteristics 3-5 times per week. Further, the was expensive, and a similar The majority of respondents were predominant portion of students proportion believed that junk food from Nigeria and India, with fewer reported using their electronic was cheaper (Table 4). participants from Ghana, Tanzania, devices for 8 hours or more daily and Morocco (Table 1). Of the 155 (62%; Table 2). General Medical Checkups participants, 49% were male and More than half of the students Substance Use Habits 51% were female (Table 1). There polled (53.5%) stated that they never were significantly fewer participants Most of the students were not receive medical checkups. Reasons in the 26-28 year old age group habituated to alcohol and drugs, included busy schedules, (Table 1). In contrast, 20-22 years old while nearly half were habituated to deprivation of funds, inaccessibility was the largest age group. When tobacco and/or cigarettes. Among to healthcare, and lack of need or considering their year of study, the those habituated to tobacco and/or desire. Out of the students surveyed, smallest proportion of students were cigarettes, a significant proportion a substantial majority (88.9%) in year 1, with the largest number of smoked 10 or more cigarettes daily. reported no concurrent chronic students in year 4 (Table 1). In terms of alcohol consumption, disease (Table 5). Of those who did, more than one-third of students the most common were Physical Activity and Health reported drinking daily (Table 3). hypertension, diabetes mellitus, and Assessments The vast majority of the students anxiety/obsessive-compulsive The data elucidated that the surveyed were aware that substance disorder. In terms of self-reported majority of surveyed students (86%) use may affect their health. health ratings, a significant had good or excellent capacity for Additionally, a significant portion of proportion of students rated their 8 vol. 0 • no. 0 American Journal of Lifestyle Medicine health as 9 or 10, with only a small may be more prone to developing such as cardiovascular disease and proportion rating their health as 5 or sedentary lifestyles.15 To promote non-cancer lung disease.20 lower. Furthermore, most students better health among students, we Furthermore, 38.1% of the rated local hospitals as average or recommend implementing students were regular consumers of above average, with only a small wellness initiatives such as support alcohol, which is substantially percentage rating them as below centers, frequent health higher than the 7.3% daily average or extremely poor (Table 5). assessments, health coaching, and consumption rate reported by more social engagement a study on Ukraine’s international opportunities.16 Furthermore, students.21 Subsequently, we Discussion a considerable proportion of the propose that the alarming rate of The health and well-being of students (62.6%) utilize their substance use could be a coping university students is an important electronic gadgets for over 8 hours mechanism for academic-induced global issue, and this study aims to daily (Table 2). This promotes stress.22 Data gleaned from this shed light on certain sedentary a sedentary lifestyle and increases study increases relevance when habits that can increase the risk of the risk of developing ailments confronted with the Gignon et al. chronic diseases among associated with NCDs, such as study, where 40% of students international undergraduate arthralgia, migraines, and utilized alcohol and illegal students at Sumy State University, depression.17 substance usage as a stress Ukraine. The results demonstrate reliever.23 Despite the high that, potentially as a result of Alcohol and Smoking Habits: prevalence of substance use, 97.4% Implications for Health and undiagnosed health issues, Wellness were aware of the impact on their students’ assessments of their health health. This aligns with research may not align with their actual This study recorded 52.6% of conducted among Bangladeshi abilities. The report also reveals students being addicted to tobacco students, where 95.83% of alarming rates of drug abuse, and/or cigarettes, which is slightly respondents were conscious of the including a high incidence of higher than Bettina Piko’s study, link between drug use and chronic alcohol intake and a tobacco and/or which reported 50% of students illnesses.19 This is concerning as it cigarette addiction among more commenting on their smoking-18 demonstrates awareness of the than half of the students polled. related views. This suggests that risks among youth populations, yet Concerns regarding the general smoking among students may be such a populace continues to health of the student populace are frequent, and smoking cessation participate in dangerous behaviors also raised by their excessive intake and prevention programs are without taking the potential of junk food and paucity of physical warranted to address the high repercussions into account.19 activity. incidence of tobacco use in this demographic. As a result, 42% of The Impact of Socioeconomic Physical Inactivity as a Risk the study participants described Factors on Unhealthy Eating Factor knowing friends or family members Habits The study demonstrated that who smoked. Having a large According to our study, 67.1% of although 82.6% of students claimed number of smoking family students were regular consumers of to have no health issues, only members and friends may junk food, lower than the 96.9% daily 43.2% felt they could perform daily contribute to the high percentage consumption rate among Ukrainian tasks at an exceptional level of student smokers. Previous international students analyzed by (Table 2). This insinuates research has even shown that Yurochko TP et al.21 Additionally, a potential discrepancy between 62.26% of Bangladeshi students our study found that 51.6% of the students’ perceptions of their began smoking owing to the respondents preferred to dine out health and actual abilities, possibly influence of friends and the instead of self-preparing meals as attributed to undiagnosed health imitation of family members.19 a result of their regular junk food conditions.14 Additionally, the Smoking with friends and intake. Furthermore, 45.2% of the study observed that only 23.2% of attributions may lead to peer students believed that eating nutritious students undertake regular pressure, which has been linked to food is expensive, while 43.2% exercise at a gym, while 27.7% the development of smoking believed that eating junk food is less reported no physical activity addictions.19 The long-term expensive. NCDs are often linked to (Table 2). Due to the demanding consequences are dire, as smoking LMICs,7 making it paramount to academic workload and heavy is associated with an increased risk highlight the relationship between reliance on technology, students of developing chronic illnesses socioeconomic factors and health 9 American Journal of Lifestyle Medicine nn–nn 2023 early. We hypothesize that the high the study only includes students would provide a deeper consumption of convenience foods international undergraduate understanding of the underlying may be partially attributed to the busy students from one university in influences and help tailor academic schedules of students, Ukraine, which may limit its interventions to address these which leave little time to prepare generalizability to other specific issues. Cultural norms, meals.21,24 populations or settings. social support systems, and Additionally, cultural and social perceptions of physical activity Medical Checkups: Student differences between countries may vary across different countries Attitudes and Barriers may affect the results. Secondly, and cultures, and understanding Despite the lack of medical the study relies on self-reported these dynamics could guide the checkups, the majority of students data, which may be subject to development of culturally sensitive (88.5%) rated their health as 7-10 recall or social desirability bias. interventions. on a 1-10 Likert scale, which is Participants may not accurately In addition, future research could surprisingly acceptable (Table 5). remember or report their investigate the effectiveness of However, 53.5% did not receive behaviors, or they may provide various interventions aimed at medical checkups due to various answers that are more socially promoting physical activity, factors such as high healthcare desirable than truthful. reducing substance use, and costs, busy schedules, financial Although the response rate was improving dietary habits among insecurity, lack of access to relatively high (74.9%), the sample international students. For adequate treatment, and health size is still relatively small, which example, the University of Nimes’ illiteracy. One student in the open may limit the statistical power and interventional programs, which questionnaire even mentioned the precision of the findings. included educational programs, absence of a routine medical Furthermore, the study design is peer support networks, and checkup as having no interest or cross-sectional, which means that it campus policies that encourage need to have one. Also, 50.4% of only captures a snapshot of the healthy behaviors, should be students surveyed reported that the participants’ behaviors and attitudes emulated.25 Evaluating the healthcare system in their town was at 1 point in time. It is not possible to outcomes of such interventions in in ordinary to poor condition, determine causality or changes over terms of behavior change, health which might have a negative time using this design. Additionally, outcomes, and overall well-being impact on students’ willingness to there is no control group in this would provide evidence-based undergo health checks (Table 5). study, which makes it difficult to strategies for improving the health To assist students who will determine whether the observed of international student constitute the future workforce, it associations are due to the exposure populations. Furthermore, is important to provide or other factors. considering the potential barriers educational and occupational The study used basic statistical and challenges faced by training on the latest health methods, which may not be adequate international students, measures to mitigate resistance for complex analyses or data with interventions should also address and barriers to behavior multiple confounding variables. The factors such as financial modification, facilitating ease of lack of more advanced statistical constraints, limited access to access. Resource assessment techniques may limit the validity and healthcare, and cultural planning, behavioral reliability of the results. Overall, these adaptation difficulties. Providing interventions, and active student limitations should be considered resources and support systems participation in NCD prevention when interpreting the study’s findings. that specifically target these programs should also be challenges can help overcome established and integrated into barriers to adopting healthier university curricula to enhance Future Research and lifestyles. healthy living. This would help Interventions To improve understanding of bridge the gap between students While this study provides sedentary behaviors among and a healthy lifestyle. valuable insights into the health international students, future behaviors of international research should address the undergraduate students, there are current study’s limitations. This Limitations several areas that warrant further can be achieved through The study has several limitations investigation. Exploring the impact longitudinal and qualitative that may affect the generalizability of cultural factors on sedentary studies that track behaviors over and validity of its findings. Firstly, behaviors among international time and reveal the underlying 10 vol. 0 • no. 0 American Journal of Lifestyle Medicine reasons and motivations for Funding 16. BMC Publ Health. 2022;22(1): sedentary behaviors. Additionally, 713-722. comparative studies across The author(s) received no financial support for the 6. Pavlović R, Solaković S, Simeonov A, research, authorship, and/or publication of this article. universities or regions can identify Milićević L, Radulović N. Physical activity and health: The benefits of variations in sedentary behaviors physical activity in the prevention of based on university characteristics Ethical Approval diabetes mellitus and cardiovascular or cultural backgrounds. Ethical approval for this study was waived by the Sumy disorders. European Journal of Furthermore, targeted State University Ethics Committee, as the research was Physical Education and Sport Science. interventions should be deemed to pose minimal risk to participants. 2022;9(1):22–43. developed and evaluated to 7. Ashdown-Franks G, Vancampfort D, address specific determinants of Firth J, et al. Association of leisure-time Informed Consent sedentary behavior with fast food and sedentary behaviors. carbonated soft drink consumption Informed consent was obtained from participants prior among 133,555 adolescents aged 12- to the online survey. Participants were provided with 15 years in 44 low-and middle-income Conclusion a clear and detailed explanation of the study aims and countries. Int J Behav Nutr Phys Activ. methods, and were given the opportunity to ask 2019;16(1):35-41. This study found that a high questions. Participants provided consent to participate percentage of international by clicking “I agree” after reading a statement that 8. Yelizarova O, Stankevych T, Parats A, students at Sumy State University explained the study and their rights as participants, Antomonov M, Polka N, Hozak S. are aware of the risks associated including the right to withdraw from the survey at any Specific features of the Ukrainian time without penalty. urban adolescents’ physical activity: A with substance use and chronic cross-sectional study. J Environ Public illnesses. However, a significant Health. 2020;2020:3404285. number of students still engage in ORCID iD 9. 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